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Mrs. Aviva Harpaz Menaheles

Linda Peck Principal

Part A: Information Sheet

Names and ages of siblings:

APPLICATION: PAGE 1 OF 3

Student’s name: Student’s full Hebrew name: Student’s birth date: Street address: Phone number: Student’s current grade: School currently attending: Schools attended previously (include years):

Schools siblings attend:

Father’s name: Mother’s name: Hebrew name: Hebrew name: Street address: Street address: Daytime number: Daytime number: Cell Phone: Cell Phone: Email: Email: Occupation: Occupation: Employer: Employer: Work address: Work address: Parent’s marital status: Shul/ Synagogue: Affiliation: Rabbi’s name: Phone number:

Please attach a recent photo of applicant to top right hand corner of this page. Tel. 757-627-BINA (2462) • Fax. 757-627-2461 • 420 Spotswood Avenue • Norfolk, VA 23517 • www.binahighschool.com


Mrs. Aviva Harpaz Menaheles

Linda Peck Principal

Part B: Academic Information

Please include two letters of recommendation from the administration or faculty of your current school. Please include contact information. Please include two personal references. List their names, titles, relationships to you, and telephone numbers. 1. 2. Please detail any specific academic strengths or weaknesses you have. If your child has an IEP or you are requesting classroom modifications, please attach those as well as any evaluations and testing results you may have.

Tel. 757-627-BINA (2462) • Fax. 757-627-2461 • 420 Spotswood Avenue • Norfolk, VA 23517 • www.binahighschool.com

APPLICATION: PAGE 2 OF 3

Please submit a copy of your school transcripts for both Judaic and Secular Studies for the most recent two years of school.


Mrs. Aviva Harpaz Menaheles

answering.

TO BE FILLED OUT BY APPLICANT

The following are some questions to help us get to know you. Please take your time before

1. What is your favorite subject and why? 2. What is your least favorite subject and why? 3. What, if any, extra-curricular school activities are you involved in?

APPLICATION: PAGE 3 OF 3

Part C:

Linda Peck Principal

4. How have you spent your last two summers?

5. Have you held any jobs in the past? ______ If so, please describe:

6. List some hobbies or activities you enjoy in your spare time: 7. Choose one person in your life who has made an impression upon you. Why? 8. What are some of your talents? Describe ways in which you’ve used them. 9. List one goal that you hope to accomplish. 10. What are you looking for in a high school? Optional: 11. Let us know what you’re all about! Have we forgotten to ask about something you’d like to tell us? Here’s your chance.

Tel. 757-627-BINA (2462) • Fax. 757-627-2461 • 420 Spotswood Avenue • Norfolk, VA 23517 • www.binahighschool.com


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